A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation

Abstract

BackgroundDespite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills.MethodsA multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study.ResultsEleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use.ConclusionsDespite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1807-6) contains supplementary material, which is available to authorized users.

Promoting Therapists’ Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation

“…Levac et al [26] report findings from the current study related to changes in therapists’ knowledge and self-reported skills related to VR system use. The current study was designed to address the following question: Does participation in a KT intervention influence therapists’ confidence, clinical reasoning, and observed application of MLS during VR interventions?…”

“…Therapists were expected to become proficient at understanding the VR system, its games and its technical operation [26] in addition to reviewing MLS knowledge and adapting MLS use to this approach. The KT intervention did not include the opportunity to practice using a motor learning VR approach with a standardized client prior to implementing the IREX with therapists’ own clients.…”

“…E-learning modules: In addition to one e-learning module instructing therapists on the use of the VR system and its games [26], two e-learning modules presented information about neuroplasticity, MLS, motor learning attributes of VR systems, and implementation of MLS into VR-based therapy. Examples of learning objectives included the ability to provide examples of using motor learning principles in practice, to describe how to link skills practiced in VR to real-life skills or activities, and to list ways to incorporate variable practice into VR-based therapy.…”

“…The principal investigator (PI) conducted a 1.5-hour focus group at each site at the end of the study to explore therapists’ perspectives on the KT intervention, their use of the IREX in practice (reported in [26]) and their experience of integrating MLS use into VR-based therapy. The focus group was audio-recorded and transcribed for analysis.…”

Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review

“…Failure to engage therapists in this way may result in discrepancies between their needs and what the technology can offer [19]. Addressing environmental and resource barriers early in the implementation process (eg, funding, treatment space requirements, location, technical and clinical personnel support, time to learn and to use) can also promote the likelihood of success [6,19]. For optimal effectiveness, KT interventions should target identified barriers and facilitators of change [36].…”